A major new study investigating the safest and most effective way to monitor blood sugar levels during labour in women with gestational diabetes has opened at Jessop Wing,
The GILD (Glucose Control in Labour with Diabetes) trial, which is being funded by a National Institute for Health and Care Research (NIHR) grant, could shape future national diabetes management during labour.
Researchers will examine if less frequent finger-prick blood glucose testing combined with monitoring of a wider glucose target range is as effective as the current standard of hourly testing.
Gestational diabetes is a common pregnancy complication that causes high blood sugar levels, potentially impacting both maternal and infant health. During labour those diagnosed with the condition are typically monitored closely and may receive insulin if needed to maintain blood glucose within a recommended target range. This reduces the risk of complications for their baby, particularly neonatal hypoglycaemia, or low blood sugar after birth.
How will the trial work?
Current standard practice in many NHS maternity units involves rapid point of care finger-prick blood glucose testing every hour, with the goal of ensuring blood sugar levels are maintained with a range of 4 to 7 mmol/L. This is called 'tight' monitoring.
The trial will compare this approach - which can feel intrusive and may contribute to a more medicalised birth - with a more relaxed monitoring strategy. This will involve finger-prick blood glucose tests taken every two to four hours during labour and ensuring a glucose target range of 4 to 10 mmol/L.
All participants will be given a continuous glucose monitor which will be applied to the back of their upper arm after 37 weeks of pregnancy. This will automatically record glucose levels during labour. The data from this will then be used to assess how closely blood sugar levels align with the allocated monitoring strategy. Neither the participant nor clinical team will have access to this during labour.
In addition, blood glucose will continue to be monitored in the usual way via finger-prick testing and in line with the requirements of the clinical team.
Helping to improve future maternity care
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Jennifer joined the study to help improve maternity care for others
Another key aim of the trial will be to examine the study's impact on neonatal unit admissions, maternal and neonatal health outcomes, participants' experiences of care and the relative costs of the two approaches to the NHS.
Jennifer, one of the first participants to join the study at Jessop Wing, said: "It feels important to me to be part of these studies to help to improve maternity care for future generations, and perhaps one day my own children."
Kimberley Clark, GILD Principal Investigator and GDM Midwife at Jessop Wing, said: "We are committed to giving all our patients the opportunity to take part in maternity research. This is an important study, which could really make a difference to pregnancy experiences and care. Controlling blood sugar during delivery and labour plays a crucial role in minimising risks for both mother and baby. What's exciting is that patients won't have too wait long for answers as the trial is designed in such a way that swe could see results very soon, meaning even those taking part in the trial who might have more children in the future could stand to benefit further. We'll also gain better understanding of labour experiences, making sure voices are heard and care improved."
Over 1,600 participants will be recruited into the trial across the UK, with participants randomly allocated to receive either the tight or more relaxed monitoring during labour. The research is being supported by the diabetes team at Sheffield Teaching Hospitals NHS Foundation Trust.
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